RE: Restraints? Survey question, of course

[Faye Jones]

By your description unless he could readjust clothing or something if the tray was out of the way, I can’t see where it is a restraint. If you feel it does in some obscure way meet the definition, we sometimes use the phrase “_______for positioning that inadvertently restraints by______________” and then care plan like a restraint.  We have had a few that have had double restraints and have not had a problem with survey with good documentation and care planning.  2 scenarios that we do see on occasion are: 1) lap tray to keep from leaning forward and pommel cushion to keep from sliding pelvis forward. 2) lap tray with seat belt (same rational). From your description, I might grudgingly be forced to agree with their definition in the end but the benefit of your plan seems to bee of great benefit to the resident and I would fight to the death to not change it.  Well maybe not to the death HA!! Also, when using double restraints it is important to show the trail of less restrictive measures attempted. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Holly Sox, RN, RAC-C Sent: Wednesday, December 03, 2003 9:49 AM To: [EMAIL PROTECTED] Subject: Restraints? Survey question, of course   Hi, Group! Survey team leader was asking about a resident with potentially double restraint.  I have not coded this resident as having a trunk restraint. He has virtually no voluntary movement in his lower extremities and very poor balance and safety awareness.  He has a lap tray when he is up in his chair, because otherwise he slides out.  It is not restricting any access to his body, at least not in my opinion.  He does flail his arms and hands at times, reaching and grabbing at others, and punches/hits at times.  He has an order for soft wrist restraints during care, which are used only if he is combative, and this is addressed and care planned.   The double restraint issue has sprung from a table that activities has set up for his use in the dining/activity area.  It is a half-circle table, that he is placed behind with a "busy box" of toys and things to play with.  He is able to reach and grab and play without the chance of harming others.  We still use the lap tray because the table does not prevent him from sliding out of the chair.   So, is there anyone (or more than one) out there who can give me some guidance on this?  He seems truly happy when he is up at the table, and is able to interact/socialize with other residents and staff safely.  I can't see removing the lap tray.  The lap tray alone is not enough of a barrier to keep him from hitting others.  If the lap tray is truly a restraint, then is there ever a situation where a double restraint is acceptable?  Is there any documentation of this?  Thanks!! Holly F. Sox, RN, RAC-C Clinical Editor, Careplans.com www.careplans.com    [EMAIL PROTECTED]